Creepy crawlers

Without the drug, it is difficult to prevent re-infestation, but good hygiene helps.

By RX FOR READERS/JUDY SIEGEL-ITZKOVICH
Stressed mom and kids (photo credit: ING IMAGE/ASAP)
Stressed mom and kids
(photo credit: ING IMAGE/ASAP)
My two-and-a-half-year-old daughter suddenly woke up in the middle of the night crying terribly. We had noticed she was itching and scratching her anus and even her vagina.
We took her to the doctor, who said she had worms in her colon. It was frightening.
We had never heard of such a thing. The doctor gave us a liquid for her to drink to kill the worms and advised that both of us drink it to, as we might have been infected. He also said we had to wash the bedclothes and towels at 70 degrees Celsius. It is not clear to me when I should start washing the towels and bedclothes – immediately, or after she gets the drug once or more? As I am breastfeeding and cannot take the drug myself, the doctor said I should eat garlic. Does this really kill the worms or just make them ‘run’ away? My daughter attends a nursery school every day. Please tell us what these worms are; how big they are, what they look like. How did they get to my child? Where and how could she have been infected with them? Could the nursery school be dirty? Do the child carers spread the worms from under their fingernails or is it the toilet? What is the drug, and how fast does it kill the worms? As we are having guests for Shabbat, I am worried that they could be infected as well. Do adults get infected easily? Is there any way to prevent children from getting and transmitting these worms? R.S., Jerusalem Dr. Maskit Ben-Meir, pediatric infectious disease expert at Jerusalem’s Shaare Zedek Medical Center, replies: Pinworms are very common in young children all over the world, almost as much as head lice. So your daughter is in good company. She undoubtedly got them in nursery school from other toddlers via towels or sheets, food or under the fingernails of the nursery school caregivers if they did not wash properly. But they can’t really be blamed. The worms and eggs are transmitted person to person and are an unpleasant nuisance, because they do cause itching, but do not result in infections or disease. Unlike head lice, they don’t suck the blood.
Both boys and girls can get them, but in girls, they can enter the vagina and cause itching by moving from the anus.
Your child probably was in contact with the pinworms’ eggs. The child and the parents in close contact should take the drug mebendazole, pyrantel pamoate or albendazole (commercially known as Vermox) twice, 10 days apart, with the second dose to kill the resulting eggs. Underwear should be changed regularly and washed, along with towels and sheets, in hot water until the worms and eggs are killed off.
Complications are very rare. In most cases, they are not invasive, but they can get into the mucous membrane of the gastrointestinal tract or the vagina. The worms themselves are very small and light yellow. You can put a piece of Scotch tape on the anus at night and look for them in the morning. If you give your daughter a warm bath in the morning, The worms are likely to leave and then die. The worms cannot be detected in a culture.
The drugs are not absorbed in the blood, thus there is no reason for pregnant or lactating women not to take it. Garlic can help get rid of the worms (but not the eggs), so it’s preferable to take the medication. Eggs can survive for several weeks outside the body.
At my hospital clinic with 1,800 children being treated for infectious conditions, I see children with pinworms every day. I have five children of my own, and some of them too had the worms when they were young.
Prof. Kosta Mumcuoglu, a leading parasitologist at the Hebrew University, adds: The child is infested with Enterobius vermicularis, better known as pinworm, and the infection is called enterobiasis, which is one of the most common worms in small children worldwide.
Infection usually occurs through the ingestion of pinworm eggs, via food, contaminated hands or, less commonly, water.
The main symptom is itching in the anal area. The incubation time from ingestion of eggs to the eggs first appearing around the anus is between four and six weeks. The worms and eggs don’t like heat, but they survive in the cold. The worms don’t lay their eggs in the stools, but sometimes eggs are deposited in the intestine. Garlic has been used to treat the condition since ancient times in Egypt, Greece, China and India.
It has to be treated but is nothing to worry about. The infestation of adults is much more seldom and the treatment is most probably a precaution so as not to not infest your child. About a third of people with the worms have no symptoms. You should, however, know that she can be re-infested from the kindergarten when in contact with other children. Speak to your pediatrician about treating your daughter periodically.
Without the drug, it is difficult to prevent re-infestation, but good hygiene helps.
Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 9100002, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to jsiegel@jpost.com, giving your initials, age and place of residence.